Katatere bağlı inatçı sol ana koroner arter spazmı

Fifty one year old female patient was taken into the catheter laboratory for coronary angiography with the diagnosis of typical angina pectoris (CCS Class 2). A 6F JL4 Judkins catheter was placed into the left coronary artery.Immediately after sitting into the left main artery, damping in the pressure tracing was seen and catheter was removed from left main coronary artery (Figure 1). There was a 90% stenosis in the left coronary artery ostium which was seen in the non selectively taken image. LAD and Cx were seemed to be normal. 200 micrograms of nitroglycerin was non selectively administered for the possibility of left coronay artery spasm. 5F JL4 catheter was placed into the left coronary system very delicately. Because damping in the pressure recording recurred, catheter was removed. After administrating 200 micrograms of nitroglycerin a 5F JL4 catheter with two side holes was placed delicately. The procedure was terminated because of the pressure damping and chest pain. RCA was seen to be normal. After taken into the coronary unit, beta blocker therapy was switched to calcium channel blocker therapy and 24 hours of intravenous nitroglycerine infusion was administered. A multislice CT was planned to evaluate the suspected lesion in the left main coronary ostium. In the MSCT was reported that left main coronary ostium was normal and patient was treated medically (Figure 2). The patients with left main coronary lesions are the most risky patients in terms of complication. Therefore, pressure damping should be evaluated immediately after placing into the left coronary system. Damping is entity which is often seen in patients with severe left coronary lesions. Another finding suggestive of severe left main lesion is that no reflux of radiocontrast agent into the aorta is seen. In patients with no other obstructive lesions in the other coronary vessels before preceding to the diagnosis of "isolated coronary ostial lesion", the possibility of catheter induced coronary spasm should be evaluated.This spasm can persist, as occurred in our case, even after recurrent nitroglycerin administration and attempts for placing into the left system with delicate maneuvers and smaller catheters. Multislice CT should be kept in mind to evaluate the left coronary ostium in these group of patients.MSCT is an assisting imaging modality for diagnosis in these group of patients (1,2).Fifty one year old female patient was taken into the catheter laboratory for coronary angiography with the diagnosis of typical angina pectoris (CCS Class 2). A 6F JL4 Judkins catheter was placed into the left coronary artery.Immediately after sitting into the left main artery, damping in the pressure tracing was seen and catheter was removed from left main coronary artery (Figure 1). There was a 90% stenosis in the left coronary artery ostium which was seen in the non selectively taken image. LAD and Cx were seemed to be normal. 200 micrograms of nitroglycerin was non selectively administered for the possibility of left coronay artery spasm. 5F JL4 catheter was placed into the left coronary system very delicately. Because damping in the pressure recording recurred, catheter was removed. After administrating 200 micrograms of nitroglycerin a 5F JL4 catheter with two side holes was placed delicately. The procedure was terminated because of the pressure damping and chest pain. RCA was seen to be normal. After taken into the coronary unit, beta blocker therapy was switched to calcium channel blocker therapy and 24 hours of intravenous nitroglycerine infusion was administered. A multislice CT was planned to evaluate the suspected lesion in the left main coronary ostium. In the MSCT was reported that left main coronary ostium was normal and patient was treated medically (Figure 2). The patients with left main coronary lesions are the most risky patients in terms of complication. Therefore, pressure damping should be evaluated immediately after placing into the left coronary system. Damping is entity which is often seen in patients with severe left coronary lesions. Another finding suggestive of severe left main lesion is that no reflux of radiocontrast agent into the aorta is seen. In patients with no other obstructive lesions in the other coronary vessels before preceding to the diagnosis of "isolated coronary ostial lesion", the possibility of catheter induced coronary spasm should be evaluated.This spasm can persist, as occurred in our case, even after recurrent nitroglycerin administration and attempts for placing into the left system with delicate maneuvers and smaller catheters. Multislice CT should be kept in mind to evaluate the left coronary ostium in these group of patients.MSCT is an assisting imaging modality for diagnosis in these group of patients (1,2)

Streptokinaz ile tedavi edilen akut miyokart infaktüsünde gelişen retroperitoneal hematom : Olgu sunumu

Retroperitoneal hematom (RPH) çoğunlukla travma, vasküler lezyonlar, cerrahi girişim, antikoagülan tedavi ve bazen de idiyopatik olarak görülebilen ve ölümcül seyredebilen bir durumdur. Çoğunlukla destek tedavisinin yapıldığı, çok az vakada cerrahi girişimin uygulandığı bir durumdur. Akut miyokart infaktüsü (Anterior) tanısıyla 78 yaşındaki bayan hastaya streptokinaz tedavisi verildi. Streptokinaz sonrasında şiddetli sol yan ağrısı, sırt ağrısı ve uyluk ağrısı başladı. Sol alt extremitede hareket kısıtlılığı ve parastezi gelişti. Herhangi bir travma, düşme yada antikoagülan kullanım öyküsü yoktu. Hastaya intraabdominal kanama şüphesi ile abdominal BT çekildi ve retroperitoneal alanda hematom ile uyumlu lezyon gözlendi. Bunun üzerine hastanın antikoagülan ilaçları kesildi ve hastaya eritrosit süspansiyonu verildi. Hastanın abdomen USG ile takiplerinde hematom boyutlarında artma gözlenmedi. Klinik olarak şikayetleri gerileyen vital bulguları stabil seyreden hasta kontrole çağrılarak taburcu edildi. Literatürde streptokinaza bağlı RPH vakası nadir bulunmasından ötürü bu vakayı paylaşmayı uygun buluyoruz.Retroperitoneal hematoma (RPH) is a potentially life threatening condition commonly associated with trauma, vascular lesions, surgical intervention and anticoagulant therapy which may occasionally be seen as an idiopathic presentation. Treatment of RPH is usually supportive, with only a minority of cases undergoing surgical intervention. A 78 year old female diagnosed with acute myocardial infarction (anterior) received streptokinase treatment. She had severe left side pain, back pain and thigh pain following streptokinase administration. Paresthesia and movement restriction developed in her left lower extremity. The patient reported no history of trauma, falling or anticoagulant use. CT was performed due to suspected intraabdominal hemorrhage, and a lesion consistent with hematoma was detected in the retroperitoneal area. Subsequently, anticoagulant medications were discontinued and the patient received erythrocyte suspension. Size of the hematoma was not increased in the follow-up abdominal USG. Upon regression of her clinical complaints and with stabile vital findings, the patient was discharged and scheduled for a control visit. We would like to report this case as streptokinase related RPH cases are rare in the literature

Aortik elastisite ve aortik elastisitenin sol ventrikül dolum ve diyastolik parametreleri ile ilişkisinin transtorasik ve transözofajiyal ekokardiyografi değerlendirilmesi

Amaç: Aort boyutlar ve elastik özelliklerini transtorasik ekokardiyografi (TTE) ve transözofageal ekokardiyografi (TEE) ile karşılaştıran sınırlı veri vardır. Bu nedenle, TTE ve TEE elde edilen aort boyutlar ve aortik elastik indekslerinin karşılaştırmanın yanı sıra bunların sol ventrikül (LV) dolum ve diyastolik parametreleri ile ilişkisini araştırmayı amaçladık. Yöntem: Çalışmaya kırk iki hasta dahil edildi. Tüm hastaların TTE ve TEE kayıtlarından aort boyutları ve ilgili elastikiyet parametreleri, sol ventrikül dolum ve diyastolik parametreleri, sol atriyal volüm indeksi (LAVİ), sol ventrikül kütle i n- deksi hesaplandı. TTE ve TEE elde edilen aort elastikiyeti indeksleri ve sol ventrikül dolum ve diyastolik parametreleri için korelasyon analizi yapıldı. Bulgular: TTE ve TEE ile elde edilen aort boyutları ve elastikiyeti indeksleri arasında anlamlı bir fark yoktu. Korelasyon analizinde yaş, E / A, E / E`ve LAVİ hem TTE hem de TEE ile edilen aort elastikiyeti indeksleri ile anlamlı derecede ilişkili iken, sol ventrikül kitle indeksi sadece TEE ile elde edilen aort elastikiyeti indeksleri ile ilişkili saptandı. Sonuç: TTE ile karşılaştırıldığında, TEE elde edilen aortik elastik özellikleri sol ventrikül dolum ve diyastolik parame treleri ile daha yakından ilişkili bulunmuştur. Buna ek olarak, TEE ve TTE ile elde edilen aort fonksiyon indeksleri iyi gözlemci içi ve gözlemciler arası değişkenliği ile benzerdir.Background: There are limited data comparing aortic d imensions and elastic properties between transthoracic echocardiography (TTE) and transesophage al echocardiography (TEE). Therefore, we aimed to investigate aortic d imensions and indices of aortic elastic properties as well as their relation with left ventricular (LV) filling and diastolic parameters obtained from TTE and TEE. Method: Forty two patients were included in the study. Aortic dimensions and related elasticity parameters, LV filling and diastolic parameters, left atrial volume index (LAVi), LV mass index were calculated from TTE and TEE recordings in all patients. The correlation analyses were performed for aortic elasticity indices and LV filling and diastolic parameters obtained from TTE and TEE. Results: There were no significant differences in aortic d imensions and elasticity indexes obtained from TTE and TEE. The correlation analysis r evealed that while age E/A, E/E` and LAVi were significantly correlated with aortic elasticity indexes obtained from both TTE and TEE, LV mass index was significantly correlated with only TEE aortic elasticity indices. Conclusion: When compared to TTE, aortic elastic properties obtained from TEE were more closely related with LV filling and diastolic parameters. In addition, the indexes of aortic function were comparable between TEE and TTE with good intra and interobserver variability

Increased pentraxin -3 level in patients with slow coronary flow

Amaç: Koroner yavaş akım (YKA), anjiyografisinde normal koroner arterlere sahip olup opak maddenin koronerlerin distaline geç ulaşması ile karakterizedir. YKA’ın inflamasyon ve yüksek duyarlıklı C reaktif protein (hs -CRP) gibi inflamatuvar belirteçler ile ilişkisi bilinmektedir. Pentraksin -3 (PTX -3), yeni bir akut faz reaktanı olup CRP gibi pentraksin ailesinin bir üyesidir. Biz bu çalışmada YKA hastalarında PTX - 3 düzeyini araştırdık. Yöntem: Çalışmaya YKA saptanan 25 hasta ve koroner arter hastalığı (KAH) olan 26 hasta alındı. Yavaş koroner akım ve KAH tanısı koroner anjiyografi ile konuldu. Kardiyoloji polikliniğine başvurmuş iskemik bulguların gözlenmediği 24 sağlıklı birey kontrol grubu olarak alındı. Tüm grubun PTX -3 ve hs-CRP çalışıldı . Bulgular : KYA grubundaki hastaların PTX -3 ve hs-CRP seviyesi kontrol grubuna göre daha yüksekti(sırasıyla 0.52 ± 0.2 ng/ml ve 0.20 ±0.08 ng/ml, p< 0.001; 1.1±0.4 mg/dl ve 0.6±0.5 mg/dl, p< 0.001). Ancak KYA grubu ile KAH grubu arasında serum PTX -3 ile hs-CRP seviyesinde fark bulunmadı (sırasıyla 0.52 ± 0.2 ng/ml ve 0.58 ± 0.18 ng/ml, p: 0.24; 1.1 ± 0.4 mg/dl ve 1.1 ± 0.6 mg/dl; p: 0.32). Korelasyon analizi sonucu serum PTX -3 ve hs-CRP seviyeleri birbirleriyle ilişkili bulundu. (Rho=0.34, p: 0.003). Sonuç : PTX -3, yeni bir inflamatuvar marker olup YKA olan hastalarda yükselmiştir ve bu hastalarda inflamatuvar durumu yansıtmada bir belirteçtir.Objective : Slow coronary flow (SCF) is defined as late opacification in the epicardial coronary artery without significant stenosis on the coronary angiographic images. The association between SCF and inflammation and inflammatory markers such as high sensitivity-C reactive protein (hs -CRP) is well known. Pentraxin -3 (PTX -3), a new acute phase reactant, is a member of pentraxine family like hs-CRP. We investigated the association between PTX -3 and hs-CRP in patients with SCF. Method : The study included 25 patients with SCF and 26 patients with coronary artery disease (CAD) whose diagnoses were made by coronary angiography. The control group consisted of 24 healthy subjects admitted cardiology outpatient clinic without any sign of ischemia. From the all study population PTX -3 and hs-CRP levels were measured. Results : The SCF group had significantly increased PTX -3 and hs-CRP levels than the control group (0.52 &plusmn; 0.2 ng/ml vs 0.20 &plusmn;0.08 ng/ml, p&lt; 0.001; 1.1&plusmn;0.4 mg/dl vs 0.6&plusmn;0.5 mg/dl, p&lt; 0.001, respectively). However there were no differences in levels of PTX -3 and hs-CRP between the SCF and the CAD groups (0.52 &plusmn; 0.2 ng/ml vs 0.58 &plusmn; 0.18 ng/ml, p: 0.24; 1.1 &plusmn; 0.4 mg/dl vs 1.1 &plusmn; 0.6 mg/dl; p: 0.32, respectively). Correlation analysis revealed a positive correlation between serum PTX -3 levels and hs-CRP levels (r=0.34, p: 0.003). Conclusion : PTX -3, a novel inflammatory marker, is elevated in patients with SCF and may be reflecting the inflammatory status in patients with SCF

Association between red cell distribution width (R DW) and Hs-CRP in patients w ith cardiac syndrome X

Amaç: Kardiyak Sendrom X(KSX), angina pektoris ve objektif iskemi bulgularına rağmen normal koroner arterlerin saptandığı bir tablodur. KSX’ in patogenezinde inflamasyonun rol oynadığı bulunmuştur. Eritrosit dağılım genişliği (RDW), dolaşımdaki eritrositlerin büyüklüğünü gösteren bir indeks olmasının yanında, son çalışmalarda inflamasyonu gösteren bir parametre olarak değerlendirilmeye başlanmıştır. Biz bu çalışmada KSX olan hastalarda inflamasyon ile RDW arasındaki ilişkiyi araştırdık. Yöntem: Bu çalışmaya iskemik bulguların saptandığı koroner anjiyografisi normal olan 35 KSX hastası (KSX grubu), ciddi koroner arter hastalığı bulunan 35 hasta (KAH grubu) ve 34 kontrol hastası alındı. Her üç gruptan RDW ve hs -CRP çalışıldı . Bulgular : KSX grubunda RDW değerleri kontrol grubuna göre artmış bulundu (13.9 ± 1.2 vs 12.9 ±0.7, p < 0.001). Ancak KSX grubu ile KAH grubu arasında fark bulunmadı (13.9 ± 1.2 vs. 14,1 ± 1,1, p: 0. 63). Aynı şekilde KSX ile KAH grubu arasında hs-CRP değerleri arasında fark yoktu(1.03 ± 0.5 vs. 1.05 ± 0.5, p: 0.92). Kontrol grubu nda hs-CRP düzeyi KSX ve KAH grubuna göre anlamlı bir şeki l de düşük bulundu. RDW ile hs- CRP arasında pozitif korelasyon olduğu bulu n du(r=0.24, p: 0.014). Sonuç : RDW, klinikte uzun süredir bilinen ancak inflamatuvar marker olarak yeni kullanılan bir parametre olup KSX olan hasta larda yükselmektedir.Objective : Cardiac Syndrome X (CSX) is defined as typical chest pain, objective signs of ischemia and normal coronary arteries. The association between CSX and inflammation is well known. Red cell distribution width (RDW), an index of erythrocyte size, is recently found to be associated with inflammation. We investigated the association between RDW and high sensitive C reactive protein (hs-CRP) in patients with CSX. Method : Total 104 patients were included in the study. Those with evidence of ischemia (total of 70) underwent coronary angiography. Patients with a normal coronary angiogram were grouped as the CSX group (n=35 )and those with significant coronary disease were grouped as the coro- nary artery disease(CAD) group(n=35). A total of 34 patients were taken as the control group. RDW and hs-CRP levels were measured. Results : RDW was increased in the CSX group when compared to the Control group (13.9 &plusmn; 1.2 vs 12.9 &plusmn;0.7, p &lt; 0.001). However, there was no difference between the CSX and CAD groups (13.9 &plusmn; 1.2 vs. 14,1 &plusmn; 1,1, p: 0. 63). Both groups had higher hs-CRP levels than the Control group. RDW is correlated with hs-CRP (r=0.24, p: 0.014). Conclusion : RDW, a novel inflammatory marker, is eleva ted in CSX and may be promising biomarker in reflecting the inflammatory status in CSX patients

Relation of presence and severity of metabolic syndrome with left atrial mechanics in patients without overt diabetes: a deformation imaging study

Objective: We aimed to investigate left atrium (LA) function by speckle tracking echocardiography in patients with metabolic syndrome (MetSyn) and to show a possible relationship between the severity of MetSyn and LA function and to determine the predictors of low strain in MetSyn patients. Methods: Our study design was observational and cross-sectional design consisted of 80 MetSyn patients without overt diabetes and 50 con- trols. The patients were classified into three groups based on the number of MetSyn criteria. The peak LA strain at the end of the ventricular systole (LAs-strain) as well as the LA strain with LA contraction (LAa-strain) was obtained. Correlation analysis performed to assess the asso- ciation of LA strain parameters with the severity of MetSyn and logistic regression analysis performed to assess the relationship of low LA strain with MetSyn. Results: Both LAs (37.5&plusmn;8.7 vs. 26.0&plusmn;10.2, p&lt;0.001) and LAa (19.9&plusmn;6.3 vs. 13.0&plusmn;6.4, p&lt;0.001) strain measurements were found to be significantly decreased in patients with MetSyn when compared to the control group. Moreover, both LAs and LAa were found to be significantly decreased with the increasing severity of the MetSyn. A multiple logistic regression analysis demonstrated that the presence of MetSyn [OR:0.26 (95% CI 0.06-0.89), p=0.032] and left ventricular ejection fraction [OR:1.14 (95% CI 1.03-1.27), p=0.021] were independent predictors of LAs strain. Conclusion: MetSyn is associated with reduced LAs strain and LAa strain representing LA reservoir and pump function, respectively. Furthermore, LA mechanical function decreases even more with the increasing severity of the MetSyn. (Anadolu Kardiyol Derg 2014; 14: 128-33)Objective: We aimed to investigate left atrium (LA) function by speckle tracking echocardiography in patients with metabolic syndrome (MetSyn) and to show a possible relationship between the severity of MetSyn and LA function and to determine the predictors of low strain in MetSyn patients. Methods: Our study design was observational and cross-sectional design consisted of 80 MetSyn patients without overt diabetes and 50 con- trols. The patients were classified into three groups based on the number of MetSyn criteria. The peak LA strain at the end of the ventricular systole (LAs-strain) as well as the LA strain with LA contraction (LAa-strain) was obtained. Correlation analysis performed to assess the asso- ciation of LA strain parameters with the severity of MetSyn and logistic regression analysis performed to assess the relationship of low LA strain with MetSyn. Results: Both LAs (37.5&plusmn;8.7 vs. 26.0&plusmn;10.2, p&lt;0.001) and LAa (19.9&plusmn;6.3 vs. 13.0&plusmn;6.4, p&lt;0.001) strain measurements were found to be significantly decreased in patients with MetSyn when compared to the control group. Moreover, both LAs and LAa were found to be significantly decreased with the increasing severity of the MetSyn. A multiple logistic regression analysis demonstrated that the presence of MetSyn [OR:0.26 (95% CI 0.06-0.89), p=0.032] and left ventricular ejection fraction [OR:1.14 (95% CI 1.03-1.27), p=0.021] were independent predictors of LAs strain. Conclusion: MetSyn is associated with reduced LAs strain and LAa strain representing LA reservoir and pump function, respectively. Furthermore, LA mechanical function decreases even more with the increasing severity of the MetSyn. (Anadolu Kardiyol Derg 2014; 14: 128-33

Metabolik sendrom varlığı ve ciddiyeti ile atriyuma ait elektromekanik gecikme ve P dalga dispersiyonu arasındaki ilişki

Amaç: Bu çalışmada, atriyum içi ve atriyumlar arası elektromekanik gecikme (AEMG) ve P dalga dispersiyonu (PDD) ile metabolik sendrom (MetS) varlığı ve şiddeti arasındaki ilişki incelendi. Çalışma planı: Çalışmaya MetS olan (n=72) ve olmayan (kontrol grubu, n=72) toplam 144 hasta alındı. MetS ciddiyetinin belirlenmesi için hastalar MetS ölçütlerinin sayısına göre üç gruba ayrıldı: Grup 1 (üç ölçütlü hastalar), Grup 2 (dört ölçütlü hastalar) ve Grup 3 (beş ölçütlü hastalar). Hastaların 12 derivasyonlu elekrokardiyografilerinden PDD ve doku Doppler parametrelerinden kulakçıklar arası ve kulakçıklar içi AEMG hesaplandı. Bulgular: Kulakçılar arası AEMG (22.9±15 ve 11.5±14, p<0.001) ve kulakçık içi AEMG değerleri (23.6±12 ve 8.3±19, p<0.001) MetS’li hastalarda, kontrol grubuna göre anlamlı olarak daha uzun bulundu. Benzer şekilde, PDD değerleri kontrol grubu ile karşılaştırıldığında MetS’li hastalarda anlamlı olarak daha uzun bulundu (49±25 ve 36±24, p=0.001). Ancak, kulakçıklar arası ve içi AEMG ve PDD’nin MetS şiddeti ile ilişkisi gösterilemedi. Korelasyon analizinde, atriyumlar arası AEMG ve atriyum içi AEMG daha çok sol ventrikül kitle indeksi ve sol atriyum hacim indeksi ile, P dalga dispersiyonu ise daha çok mitral Doppler parametreleri ile ilişkili bulundu. Çoklu değişken analizi sonucu, atriyumlar arası AEMD için, HDL-K, sistolik ve diyastolik kan basıncı bağımsız öngördürücüler olarak bulunurken; E/A ve LDL için bu değerler istatistiksel anlamlılık sınırında kaldı. Kulakçık içi AEMD için ise sistolik ve diyastolik kan basıncı, beden kitle indeksi ve E/A bağımsız öngördürücüler olarak bulundu. Sonuç: MetS’li hastalarda kulakçıklar arası ve kulakçık içi AEMG ve PDD, kontrol grubuna kıyasla daha uzundur. Fakat bu uzamanın MetS ciddiyeti ile ilişkisi yoktur.Objectives: In this study, we aimed to investigate the association between the presence and severity of metabolic syndrome (MetS) with intra- and inter-atrial electromechanical delay (AEMD) and P-wave dispersion (PWD). Study design: A total of 144 patients (72 MetS patients and 72 age- and sex-matched control subjects) were included in the study. Patients with MetS were classified into three groups based on the number of MetS criteria as follows: Group 1 (patients with three MetS criteria), Group 2 (patients with four MetS criteria) and Group 3 (patients with five MetS criteria). Intra- and inter-AEMD were measured from parameters of tissue Doppler imaging. PWD was calculated from the 12-lead electrocardiogram. Results: Both inter-AEMD (22.9&plusmn;15 vs. 11.5&plusmn;14, p&lt;0.001) and intra-AEMD (23.6&plusmn;12 vs. 8.3&plusmn;19, p&lt;0.001) were found to be significantly longer in patients with MetS than the control group. Similarly, PWD (49&plusmn;25 vs. 36&plusmn;24, p=0.001) were found to be significantly longer in the MetS patients than the controls. However, both inter-AEMD and intra-AEMD and P wave measurements were not found to be associated with the severity of MetS. While inter and intra-AEMD were better correlated with LV mass index and LA volume index, PWD correlated better with mitral inflow Doppler parameters. According to multivariate analyses, inter-AEMD, HDL-C, and systolic and diastolic blood pressure were found to be independent predictors, whereas E/A and LDL-C had borderline significance. For the intra-AEMD, systolic and diastolic blood pressure, body mass index and E/A were found to be independent predictors. Conclusion: In patients with MetS, inter- and intra-AEMD, and P dispersion were found to be lengthened when compared with the controls. However, these parameters were not associated with the severity of MetS

Çernobil nükleer faciasının insan yaşamı ve çevre üzerindeki etkileri

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2012.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by İbrahim Mert Öztürk.Öztürk, İbrahim Mert. HIST 203-06ÖZTÜRK HIST 203-06/6 2011-1

Koroner bifurkasyon lezyonlarının klinik ve morfolojik değerlendirilmesi

Amaç: Koroner bifurkasyon lezyonlarının anatomik ve morfolojik özelliklerini araştırmayı amaçladık. Çalışma planı: Çalışmaya koroner anjiyografi yapılan 542 stabil hasta alındı. Bifurkasyon lezyonları en az 2.5 mm çaplı ve en az %50 darlık olan ana dal ve yan dal lezyonları olarak tanımlandı. Bu ölçütler kullanılarak, bifurkasyon lezyonlarının varlığı ve sayısı, bu lezyonların bulunduğu damarlar, Medina sınıflandırmasına göre lezyonun tipi ve bifurkasyon lezyonunun açısı belirlendi. Bulgular: Bifurkasyon tanımına göre hastaların %19.3’ünde (n=105) bifurkasyon lezyonu vardı. Bunların %77’sinde, bifurkasyon açısı 70°’nin altında idi. Tüm lezyonların yaklaşık %37’si Medina 1.1.1 sınıflandırması ile uyumlu idi. Tüm bifurkasyon lezyonlarının yaklaşık %56’sı sol ön inen arter (LAD), %25.4’ü sirkumfleks arter (Cx) ve %12.5’i sağ koro- ner arter (RCA) bölgesinde idi. Medina 1.1.1 tip lezyonlar en sık LAD ve RCA’da gözlenirken en az Cx ve sol ana koro- ner bölgesinde saptandı. Diyabet bifurkasyon lezyonu olan hastalarda olmayanlara göre anlamlı olarak yüksek sıklıkta saptandı. Sonuç: Bifurkasyon lezyonları koroner anjiyografi pratiğinde sıkça gözlenmektedir. Bunların anjiyografik özellikleri ve bu lezyonların klinik durumla ile ilişkisi uygun girişimsel tedavinin seçiminde çok önemli olabilir.Objectives: We aimed to investigate the anatomical and morphological characterization of coronary bifurcation lesions. Study design: The study population consisted of 542 stable patients who underwent coronary angiography. Bifurcation lesions were defined as a lesion &amp;#8805;50% diameter stenosis involving a main branch and/or contiguous side branch with a diameter of &amp;#8805;2.5 mm. Using these criteria, the presence and number of bifurcation lesions, bifurcation lesion location, lesion classification according to Medina classification and the angle of the bifurcation lesion were determined. Results: According to the bifurcation definition 19.3% (n=105) of our patients had bifurcation lesions. In 77% of all bifurcation lesions, the bifurcation angle was &lt;70&deg;. About 37% of all lesions were concordant with the Medina 1.1.1 classification. Approximately 56% of bifurcation lesions were in the LAD region, 25.4% in the Cx region, and 12.5% in the RCA region. Medina 1.1.1 was the most frequently observed in the LAD and RCA regions, while it was least common in the Cx and LMCA regions. Diabetes was observed to be significantly higher in those with bifurcation lesions than in those without. Conclusion: Bifurcation lesions are frequently observed in coronary angiography practice. Angiographic characteristics and the relationship of these lesions with clinical conditions may be a crucial factor in choosing the appropriate interven- tional procedure

Kardiyak sendrom X’li hastalarda serum pentraksin-3 düzeyi artmıştır

Amaç: Kardiyak sendrom X (KSX), anjina pektoris ve objektif iskemi bulgularına rağmen normal koroner arterlerin saptandığı bir tablodur. KSX ile enflamatuvar belirteçler özellikle de yüksek duyarlıklı C-reaktif protein (hs-CRP) arasındaki ilişki iyi bilinmekte olup pentraksin-3 (PTX-3) ile ilişkisi gösterilmemiştir. Bu çalışmada, PTX-3 ile KSX arasındaki ilişki araştırıldı. Çalışma planı: Çalışmaya koroner arter hastalığı (KAH) şüphesi olan toplam 122 hasta (58 kadın, 64 erkek, ortalama yaş 49.6±5.8 yıl) alındı. İskemi bulgusu (efor testi pozitif 50 hasta, miyokart perfüzyon sintigrafisi pozitif 32 hasta) olan hastalara (toplam 82) koroner anjiyografi yapıldı. Normal koroner anjiyografisi olan hastalar (n=41) KSX grubu ve koroner lezyonu olan hastalar (n=41) KAH grubu olarak kabul edildi. İskemi bulgusu olmayan hastalar kontrol grubuna alındı. Her üç grupta PTX-3 ve hs-CRP düzeyleri araştırıldı. Bulgular: Kardiyak sendrom X grubunda PTX-3 değerleri kontrol grubuna göre yüksek bulundu (0.46±0.16 ve 0.23±0.09 ng/ml, p<0.001). Ancak KSX grubu ile KAH grubu arasında serum PTX-3 ile hs-CRP düzeyleri yönünden anlamlı fark bulunmadı (PTX-3: 0.46±0.16 ve 0.51±0.13 ng/ ml, p=0.21; hs-CRP: 1.04±0.45 ve 1.16±0.64 mg/dl, p=0.62). Kontrol grubunda hs-CRP düzeyi (0.73±0.51 mg/dl), KSX (1.04±0.45 mg/dl) ve KAH (1.16±0.64) grubuna göre anlamlı bir şekilde düşük bulundu (sırasıyla, p=0.03 ve p=0.002). PTX-3 ile hs-CRP arasında pozitif bağıntı olduğu gözlendi (r=0.30, p=0.001). Sonuç: Pentraksin-3 yeni bir enflamatuvar belirteç olup, KSX’li hastalarda iyi bilinen enflamatuvar belirteçlerden olan hs-CRP gibi yükselmektedir. PTX-3, KSX’li hastalarda enflamatuvar durumu yansıtan bir biyobelirteç olabilir.Objectives: Cardiac syndrome X (CSX) is a clinical entity that is defined as normal coronary arteries with angina pectoris and objective sins of ischemia. The correlation between CSX and inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) is well established, however an association with pentraxin- 3 (PTX-3) has not been examined. The aim of this study was to investigate the association between PTX-3 and CSX. Study design: A total of 122 patients (58 female, 64 male, mean age 49.6&plusmn;5.8 years) with suspected of coronary artery disease (CAD) were included in the study. Those with evidence of ischemia (50 patients with positive treadmill tests, 32 patients with positive myocardial perfusion scintography) underwent coronary angiography (82 patients). Patients with a normal angiogram were considered the CSX group (n=41) and patients with coronary lesions were referred to as the CAD group (n=41). Patients without signs of ischemia served as the control group. Serum PTX-3 and hs-CRP levels were measured in all patients. Results: The CSX group had significantly increased PTX-3 levels relative to the control group (0.46&plusmn;0.16 vs. 0.23&plusmn;0.09 ng/ml, p&lt;0.001). However there were no differences in levels of PTX-3 and hs-CRP between the CSX and the CAD groups (PTX-3: 0.46&plusmn;0.16 vs. 0.51&plusmn;0.13 ng/ml, p=0.21; hs- CRP: 1.04&plusmn;0.45 vs. 1.16&plusmn;0.64 mg/dl, p=0.62). The control group had significantly lower hs-CRP levels (0.73&plusmn;0.51 mg/ dl) when compared to the both CSX and CAD groups (p=0.03 and p=0.002, respectively). Serum PTX-3 levels were weakly correlated with hs-CRP levels (r=0.30, p=0.001). Conclusion: PTX-3, a novel inflammatory marker, is elevated in patients with CSX, similar to the well known inflammatory marker hs-CRP, and may be a promising biomarker reflecting inflammatory status in these patients